Hospitals 2005: Measuring Hospital Performance

The Joint Commission on Accreditation of Healthcare Organizations (jcaho.org) and the Centers for Medicare and Medicaid Services (www.cms.gov) are collaborating on a different way to identify and measure hospital data in an effort to improve hospital performance and allow greater public scrutiny.

Their methods ignore patient-outcome data. Instead, they base performance evaluations on how hospitals treat patients with specific conditions. JCAHO and CMS want to know: Did patients immediately get aspirin when they arrived at the hospital complaining of chest pain? How quickly did patients diagnosed with pneumonia receive an antibiotic? Were patients with congestive heart failure prescribed ACE inhibitors?

These performance measures were adopted by JCAHO and CMS because they're easier to ascertain than outcomes and because JCAHO president Dr. Dennis O'Leary says there is abundant evidence "that when followed, these measures become very good proxies for a good outcome." In other words, if a hospital does the right thing medically, patients should see good results.

A New England Journal of Medicine study published in July found that when JCAHO started using these measures to examine hospitals in 2002, patient care improved in 3,000 hospitals for those suffering heart attacks, heart failure, and pneumonia.

But this method has its own pitfalls. Will a hospital be penalized because a patient with an aspirin allergy isn't given one upon arrival at the ER with chest pain? Or will some hospitals focus heavily on process because they know this is how to score higher–like cramming for a test by figuring out how to answer specific questions instead of learning the subject matter?

This JCAHO evaluation method has also been criticized for providing little useful information for prospective patients. People are unlikely to choose a hospital because it gives an antibiotic in a timely way. Sarah Loughran of HealthGrades said evaluating hospitals this way is "so limited that it really tells very little."

Jerod Loeb, JCAHO's executive vice president for research, admits the measures are not where they should be right now but says new factors, such as infection prevention, will be added. "That's one of the crown jewels of hospital performance measurers," he says.

Asthma care for children, pain management, deep vein thrombosis, and nursing care will in time also become part of the JCAHO and CMS hospital evaluations.

As more measures are added, Loeb says, they will provide a clearer picture of hospital performance. Eventually, hospitals will be required to maintain a certain standard or possibly face diminished reimbursement from Medicare–and from private insurers as well.